Upraising of Eldercare Industry – A Vibrant Year 2015

This is certainly been an exciting year for the eldercare sector, in terms of the many opportunities and grant calls.

I am privileged to be intimately involved in this sector, from manpower development, research, to cutting edge technology developments.

Here are some of the events that I was involved in Singapore 2015.

Care-at-Home Innovation Grant

Everyone was excited about this very first grant call on the research thrust “Ageing in Place” under the National Innovation Challenge (NIC) on Active and Confident Ageing. MOH organized a few events to update providers and tech companies alike with networking and matching sessions.

Cognitive Grant

Following the Care-at-Home Grant call, the 2^nd grant call of the series came and we are still in the midst of writing out the proposals. The Grant Call on Cognition is the second of the grant calls under the National Innovation Challenge (NIC) on Active and Confident Ageing. This grant call under the research thrust on “lengthening health span” has two objectives. First, the innovation aims to improve cognitive functioning and delay the onset of dementia in older adults. Second, the innovation aims to provide quality and cost-effective care for seniors with dementia in the community.

NUS Enterprise Small Change Festival

Small Change is a social movement by youths and for youths, to inspire innovative solutions to address social needs in Singapore. FB/Instagram: smallchange.nus 

I was very honored to be invited as a panel speaker on the theme of Ageing. The one thing I learnt is that Silver Tsunami should be termed as Silver Reservoir instead! I learn much from other senior panel speakers and their drive and focus on Elder services are unparalleled.

Here are some photos for the event which include other social issues:

https://www.facebook.com/smallchange.nus/photos_stream?ref=page_internal

NUS Enterprise: Modern Ageing Singapore

I was invited as a judge in this event in their Semi-Final rounds. Although I have seen and come across most of the innovations, nevertheless, it was a great event to boost tech start-ups in the Eldercare sector!

Here are some news report on this event:

https://www.techinasia.com/modern-aging-winner-startups

http://www.channelnewsasia.com/news/singapore/3-teams-receive-s-125-000/2319006.html?cid=fbsg

Asia Pacific ARTT-Network: Active Ageing

Design Singapore Council: Two New Books: Publications on rethinking health and wellness for the elderly

I am very fortunate to be invited for the book launching at National Design Center and given 2 very informative books on Eldercare and their needs.

The e books are online now and here are the links!

Design for Aging Gracefully: 

http://www.designsingapore.org/for_enterprises/Design_Research/DesignforAgeingGracefully.aspx

Empathetic Technology for Ageing – Rethinking Health & Wellness for the Elderly:

http://www.designsingapore.org/for_enterprises/Design_Research/EmpatheticTechnologyforAgeing.aspx

Design Singapore Council: Designathon 2016

ABOUT DESIGNATHON 2016

Designathon 2016 is a 36-hour design challenge that will bring together a diverse group of people to produce design solutions that will enable the elderly in Singapore to live beautifully in

their golden years.

THEME: Living Beautifully: Designing for Our Golden Years

How might we design to transform the experience of ageing for the elderly in Singapore and enable them to continue living their lives with dignity, grace, and equality as they age?

I was involved in the Pre-Designathon workshop and will be joining in the Designathon next year.

Other developments:

Unaging:  http://unframed.so/unaging/

AIA-Konica Minolta Digital Health Accelerator:  http://www.aia-km-accelerator.com/

I received an invitation to join in the Global Consultation on WHO strategy recently. Unfortunately, the event in held in Geneva, in WHO HQ. Fortunately, with modern information technology available, I was able to join in the webinar and listen to the contributions by Eldercare experts all over the world. Many agendas from the Global strategy draft were discussed. I have attached the draft strategy in this article at the bottom of the page as well.

The impression I felt was ageing issues were too broad, and every different countries had slightly different focus, different political climate, different resources and very different cultures. It is rather confusing for most parts and many did not stick to the discussion agenda, but putting forth when their countries or organisations are doing. In fact, the definition of at what age should you define an older person may differ from each region. It is a 2 days long event and I was able to sit through all the sessions. 

Many of the themes regarding healthy ageing or ageing in place is not new, and has been a recurring themes in many of these forums or discussions. Themes like a conducive environment to age in, housing and financial issues, long term care  and palliative services, trained frontline manpower, health literacy and promotion, research in gerontology issues etc has been repeatedly mentioned in such forums all over the world. WHO seeks to consolidate all of these ideas into a clear framework as a guide for every country. 

As a global leader in healthcare policies, WHO will have to power to set down some ground indices for every country to follow, thus, data can be compared and best practices might be share between countries with similar socio-economic factors. Many countries, especially the local income countries, may find more challenges and perhaps impossible to implement the finalised strategies as some of the delegates shared. They can also facilitate cross countries collaborations in implementing some of the strategies. 

Each countries take their turns to speak and comment and many shared their difficulties faced and some solutions done. It is an eye opener for many of us doing gerontology work.

In the past 5 years, there has been an increasing support for home based care for elderly chronic sick, bed bound patients. The Ministry of Health and Agency of Integrated Care has done much to support the dependent elderly patients through various policies. Primary health care and long term care sectors have been in the news often and are getting the support they deserve from the policy makers.

MEANS testing has been getting less “mean” and much easier to pass in recent years. Hence, MEANS testing dependent programs such as IDAPE has seen an increase in claims in the past few years.  CHAS is another program in recent years to help subsidised patients to see doctors at private GP clinics rather than at polyclinics. CHAS provides subsidies for medical services and other perks, which traditionally only polyclinic holds. One big advantage for CHAS clinics now is the ability to refer patients to Specialist Outpatient Clinic as a subsidised patient.

It has been a heartening 3 years.  Authorities are giving more support to our group of chronic sick, bed bound patients to get treatment in their own homes. Support for home-based care is now given only to home care programs from charities and known social enterprises such as NTUC Health.

Private providers for long-term care services are unable to ride onto this program. Hence, we are only seeing those patients that either failed MEANS testing or non-Singaporean.  There is a special group of non-Singaporeans patients who have been staying in Singapore for the past 50 years but never converted to a Singaporean citizenship or even permanent residency.   For the group of patient who are unable to pass MEANS testing, many of them are actually also HDB dwellers and stays with their unmarried daughter or son with a stable income. Ironically, to pass MEANS testing, it is better for the elderly NOT to stay with their children in order to get maximal subsidies since usually the elderly will not have any active income as they are retired.

In the past, the difference between private and VWO services may not be too great, apart from subsidised consultations. But now, with subsidised medications and Pioneer Generation subsidies, my group of patients are losing out quite a bit. They will not be able to get their prescription subsidized like those in polyclinic or hospital SOCs as PG card holders.  As I do not have a physical clinic, my service is unable to be included in CHAS program.  All my referrals back to hospital SOCs will be treated as private referrals.  It would often be more cost effective to just go to the Emergency department for services such as subsidised referrals! Most of my patients are severely bed bound, hence requiring home based service.  It is very difficult or almost impossible for them to go to a CHAS GP clinics or polyclinic to see doctor or to get referrals.  I see this as huge disadvantage for my patients.  Perhaps, it would be timely for the authorities to come out with new policies to bridge such a gap for this group of patients.

I had been running subsidised home care services with various institutions for the past 7 years. I had witnessed first-hand at the many good subsidized schemes that benefitted patients.  As I had recently stop working for a VWO, some of the patients from the VWO wanted me to follow-up with them, but the difference of cost and benefits between subsidised and private service is too great.  There are also other patients whom I see along the course of my work who would like to continue to be followed up by me.  But as I know they would lose out a lot in terms of subsidized benefits, I had to advise them or refer them to be followed up by VWOs.  It seems that being a good doctor to the patient, thinking for the welfare of the patient will result in a losing situation for my own company.

Lotus Eldercare feels like we are falling through the cracks as well in terms of policy, mirroring those patients we serve.

Our last blog on the visit:

https://social.shorthand.com/LotusEldercare/nyfS1LOaF0/visit-to-lacura-group-iii

Blog link:

https://social.shorthand.com/LotusEldercare/n2xmmB6tw/visit-to-lacura-group-ii-hokkaido-japan

Our shorthand blog to the visit!

https://social.shorthand.com/LotusEldercare/j2eIT2vFYw/visit-to-lacura-group-hokkaido-japan

MIT and SMART came up with a pre-MIT Hacking Medicine workshop to introduce to us the concept of the Hacking Medicine and what it encompasses. Many people suggested better ways for technologies to help patients navigate the complexities of both the services and the available funding schemes.

Chronological age is definitely not a determinant of the services required. A 90-year-old marathon runner and a 55 year old bed bound stoke patient will require totally different set of services. However, a 90-year-old bed bound from advance dementia and on nasogastric tube feeding will likely to be requiring similar services to that of the 55-year-old stroke patient.

As a primary care as well as long term care physician practicing in the community, part of my work is to advise patients and their families with regards to the possible services they would require; how to get maximal benefits out of our complex health system and also perhaps to relieve some of the work in our congested polyclinics.

There are already informative portals such as Agency of Integrated Care (AIC) site which is very useful but still focus on services rather than the client.

As such, I will be proposing a new portal perhaps via AIC or other aging issues related statutory board, to come out with a portal with the patient in mind. To explain further, this portal will be divided into 9 categories in accordance to the clinical fragility scale. Under each category, there will be subdividual into different sections such as health, financial and social support information. For example, the 90-year-old marathoner will be clicking onto Category 1 pages, perhaps telling him on chronic diseases screening and exercise prescription information, socially on the SG 50 sponsored courses etc. The 90-year-old stroke patient will have information on home medical and nursing services, and financially advised on IDAPE, PG-DAS, FDWG and SMEF funding schemes if eligible.

As the Clinical Frailty Scale is easy to understand and categorize, with useful information stack behind these more patient orientated headings, services can be groups and organized in a more functional way for the users.

“Bringing Technology and Fund to You”

We would like to invite you to our networking event (below).

Project Yangon June 2015 with medical students from Yong Loo Lin School of Medicine, Singapore:

https://www.flickr.com/gp/134297911@N07/V069V3

Here are the links for further information on the student's project in Myanmar!

This is the link to our website: 

https://projectyangon.wordpress.com

Our facebook page: 

https://facebook.com/projectyangon?ref=bookmarks